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General cardiology, heart failure
Berlin heart beats ECMO for childhood heart failure
Heart failure is uncommon in children but carries a poor prognosis with 46% of children with severe systolic dysfunction dying or undergoing transplantation within 5 years. Survival among children after heart transplantation is 83% at 3 years, but the limited availability of donor hearts prolongs the waiting period, resulting in a high rate of death whilst on waiting lists. Options for mechanical circulatory support have been limited in children, with one choice being extracorporeal membrane oxygenation (ECMO); however, this is only capable of providing shot term support at best. More recently, the Excor Paediatric pulsatile-flow ventricular assist device (Berlin Heart) has become available in a wide range of sizes.
In this study Fraser et al tested the efficacy of the Berlin Heart as a bridge to transplant. In a prospective single-group trial, using data from a matched historical control group undergoing ECMO as a comparator, patients 16 years of age or younger were divided into two cohorts according to body-surface area (cohort 1, <0.7 m squared; cohort 2, 0.7 to <1.5 m2). The primary outcome was the time to death or weaning from the device with an unacceptable neurologic outcome; safety data were also gathered. The results in both …